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A
A
I'm
also
present,
we
have
a
quorum
and
we're
constituted
to
do
business
first
thing.
We're
going
to
do
is
address
our
consideration
of
referred
administrative
regulations.
A
I
think,
hopefully,
all
the
members
have
had
these
in
advance
had
a
chance
to
review
them.
I've
reviewed
them,
don't
have
any
particular
concerns.
I
know
we
do
have
one
agency
amendment
on
one
regulation.
If
you
take
a
look
at
902
kr002,
I
don't
know
if
miss
julie
brooks
or
if
dr
stack
are
online
and
I
was
hoping
yeah,
hopefully
you're
there,
if
you
guys,
could
introduce
yourselves
and
just
briefly
explain
the
amendment
and
what
it
does
for
the
for
the
committee.
D
Sure,
thank
you,
mr
chair,
so
julie
brooks
is
our
director
of
regulatory
affairs
over
here
in
kentucky
department
for
public
health,
this
regulation,
the
big
regulation,
is
our
reportable
disease
regulation
and
we
were
doing
regular
housekeeping
updates
to
it
last
year,
and
it
was
coming
here
today
for
its
second
reading
to
the
committee,
with
the
surge
in
the
omicron
cases,
the
in
the
outpatient
setting
the
burden
of
reporting
disease
reports
for
all
the
patients
in
the
outpatient
setting
is
is
overly
burdensome,
and
this
second
reading
allows
us
the
opportunity
to
remove
that
burden
from
offices
and
emergency
departments
in
the
outpatient
setting.
D
We
will
still
get
the
laboratory
results
which,
which
is
all
we
really
have
to
have
from
that
setting
at
this
point,
and
we
will
remove
the
burden
of
reporting
requirement
from
them
to
have
to
submit
the
longer
two-page
clinical
case
report
form
unless
somebody
is
admitted
to
the
hospital,
so
the
sickest
patients
or
someone
dies
from
covet.
So
we
are
curtailing
the
amount
of
burden
of
reporting
that
the
outpatient
setting
has
to
comply
with.
A
A
If
not
we'll,
need
to
take
action
on
that
amendment,
we
need
a
motion.
We
have
a
motion.
Is
there
a
second?
It
was.
Second,
all
those
in
favor
signify
was
saying:
aye
aye
any
opposed
all
right,
so
the
amendment
is
approved
and
let
the
record
show
that
all
these
regulations
have
been
reviewed.
Dr
stack,
thank
you
so
much.
We
appreciate
your
time
and
the
explanation.
A
The
all
right,
we
have
three
bills
for
consideration
today.
The
first
is
senate
bill
11..
This
is
an
act
relating
to
long-term
care
facilities.
I
am
the
sponsor,
so
I'm
going
to
come
down
to
the
table
there,
and
we
have
several
individuals
who
also
are
here
to
help
present
on
the
bill.
They'll
introduce
themselves
as
they
present
testimony.
I
want
to
remind
all
members.
This
is
a
bill
that
was
presented
during
the
interim,
so
we
all
had
a
chance
to
hear
a
presentation.
A
A
Thank
you,
I'm
ronald
alvarado
state
center
for
the
28th
district.
If
you
guys
want
all
introduce
yourselves
to
the
record,
I'm.
F
Living
in
licensed
personal
care.
Additionally,
I
work
closely
with
coalition
partners
in
in
the
senator
and
putting
this
bill
together.
D
E
A
You,
mr
chairman,
members
of
the
committee,
I'm
pleased
to
present
senate
bill
11.
This
is
a
bill.
That's
been
worked
on
for
the
past
two
years.
It's
required
the
collaboration
of
multiple
medical
providers
and
has
received
the
input
of
several
different
patient
advocacy
groups.
This
is
a
bill
that
was
again
presented,
like
I
mentioned
earlier
in
my
absence
during
the
interim
for
discussion.
The
purpose
of
the
bill
really
is
to
modernize
kentucky's
assisted
living
social
model
to
align
more
closely
with
the
vast
majority
of
states.
E
Senator
I
hate
to
interrupt
your
presentation,
but
you
do
have
a
a
sub
on
this
yeah.
A
A
Thank
you
so
much
so.
To
that
end,
the
bill
was
pre-filed
to
allow
review
and
input
from
multiple
agencies
and
has
been
in
the
public
speaker
for
several
months
on
the
senate
committee
sub.
That
is
now
before
us
and
there's
kind
of
some
succinct
highlights
to
that
sub
as
well.
But
I
thought
instead
of
hearing
me
discuss
this.
I
think
we've
got
some
experts
in
the
field
who
can
go
through
it.
A
I've
preferred
a
lot
of
remarks,
but
I
think
it
might
be
better
in
the
interest
of
time
if
we
let
mr
lee
talk
about
a
little
bit
about
what
the
substitute
does
again,
we've
heard
details
of
the
original
bill,
so
a
lot
of
these
are
changes
that
have
been
made
from
a
lot
of
the
input
from
different
providers.
So,
mr
lee,
if
you'd
like
to
go
over
some
of
the
changes
to
the
in
the
sub.
F
Thank
you,
mr
chairman,
and
thank
you
to
the
vice
chairman
and
the
members
of
the
committee
for
the
opportunity
to
meet
with
you
in
the
run-up
to
this
this
meeting
today
and
the
ability
and
the
opportunity
to
testify
again
to
highlight
the
changes
that
are
are
in
this
committee
sub.
F
We
listened
during
that
that
october
20
interim
joint
committee
meeting
to
questions
and
comments
from
the
members
and
also
advocacy
groups
and
the
cabinet
since
then,
and
we
thought
it
made
sense
to
take
that
step
regarding
ombudsman
and
resident
rights
and
and
the
reason
resident
rights
wasn't
applicable
before
in
assisted
living.
It
was
with
in
personal
care
setting
it
wasn't
in
assisted
living
and
that's
because,
as
a
social
model,
all
these
years
it
has
been
subject
to
landlord
tenant
laws
and
leases.
F
That
relationship
will
still
be
there
that
protection
will
still
be
there,
but
when
we
heard
concerns
about
why
not?
I
include
those
that
that
long
list
of
resident
rights
and
make
it
applicable
to
all
assisted
living
residents.
We
said:
okay,
let's
do
that,
so
we're
expanding
protection
by
making
the
statutory
rights
applicable
to
assisted
living
residents.
For
the
first
time.
F
Numerous
additional
changes
that
respond
to
concerns
raised
by
the
alzheimer's
association
have
been
made.
Most
of
those
have
been
focused
on
strengthening
alzheimer's
specific
staff
training.
I
will
say
that
we
are
only
aware
we
are
aware
of
only
one
additional
issue
with
the
alzheimer's
association
that
they
have
with
the
bill.
F
A
couple
of
changes
were
requested
by
the
hospice
association
and
we
were
successful
in
working
out
language
that
satisfied
them
and
worked
well.
Multiple
changes
were
made
that
respond
to
some
concerns
raised
by
the
cabinet
for
health
and
family
services
and
included
in
those
are
making
the
duration
between
re-licensure
surveys
12
months.
If
there
have
been
serious
violations
in
the
previous
survey
cycle,
serious
violations
that
affected
or
potentially
affected
health
and
welfare
of
residents.
F
24
months,
though,
would
be
the
duration
under
this
committee
sub.
If
there
was
a
what
I
will
characterize
as
a
good
previous
survey,
ones
where
there
weren't
serious
violations
where
they
were
more,
we
missed
a
date
on
this,
where
it
was
more
of
a
paperwork
compliance
issue.
If
you
will-
and
I
did
a
study
of
all
50
of
our
states
on
the
duration
between
re-licensure
surveys
in
assisted
living
and
the
average
was
19
months.
F
So
I
think
we
stuck
struck
a
pretty
good
balance
of
saying,
if
you're
good
provider,
if
you've
had
a
good
previous
survey,
then
24
months,
if
you've,
if
if
there
have
been
some
some
issues,
some
serious
issues
12
months
and
of
course
I'll
remind
you
that
the
cabinet
has
full
authority
to
go
in
on
a
complaint
at
any
point
in
time
and
also
has
a
full
authority
to
go
in
once
twice.
However
many
times
they
need
to
to
verify
that
the
corrections
were
timely
made
during
that
cycle.
E
I'd
like
to
invoke
privilege
of
the
chair
here,
I'd
like
to
hold
questions
until
all
the
presentations
been
made,
but
we'd
like
you
to
clarify
your
statement
about
due
process.
I
think
you
cover
that
too
generically
to
rank
and
file
people
like
me
and
not
really
understanding
what
that
issue
might
be.
F
Very
good,
senator
from
our
perspective,
the
the
we
we
carefully
built
in
going
forward
additional
protections
that
the
cabinet
will
will
oversee
when
there's
a
new
applicant
when
there's
someone
coming
in
for
a
new
building
that
has
has
not
been
previously
certified
as
al
or
assisted
living
or
licensed
his
personal
care
with
a
dementia
care
unit
when
they
apply
for
licensure.
F
The
cabinet
for
those
new
providers
will
look
at
education
of
ownership
and
management.
They
will
look
at
experience
in
in
that
realm.
They
will
look
at
statutory
and
regulatory
compliance,
whether
it's
here
or
in
another
state
and
then,
if
they
deem
in
the
cabinet's
judgment
that
that
applicant
has
insufficient
good
basis.
Thank
you.
F
For
being
a
compliant
successful
operator
in
within
the
realm
of
dementia
care,
the
cabinet
can
make
the
issuance
of
a
license
for
a
sister
living
with
dementia
care
contingent
upon
them,
agreeing
to
retain
the
services
of
a
qualified
and
the
bill
sets
out
what
the
qualifications
are.
F
A
qualified
consultant
in
that
arena
to
hold
their
hand
through
that
process
to
ramp
the
up
their
expertise,
so
that,
hopefully,
there's
a
an
excellent
compliant
experience
for
that
provider,
but,
most
importantly
for
those
residents
in
the
case
of
existing,
which
is
where
the
the
the
remaining
issue
has
been
with
the
alzheimer's
association.
F
If,
if
there's
a
significant
problem,
the
fact
that
they
are,
if
this
bill
passes,
that
they
would
automatically
then
bridge
over
subject
only
to
the
cabinet,
taking
a
strong
look
at
the
physical
plant
make
sure
it's
safe
and
in
compliance
they'd,
otherwise
be
grandfathered
in.
If
you
will-
and
we
look
at
that
and
say
if
they
were
a
bad
provider
frankly,
their
right
to
continue
doing
business
should
have
been
taken,
and
that
re-licensure
is
not
the
place
to
be
saying.
F
F
Briefly
briefly,
the
other
issues
with
the
cabinet
that
we
were
able
to
or
concerns
they
expressed.
We,
this
committee
sub
increases
from
one
year
to
seven
years,
the
period
after
which
a
licensed
revocation
before
before
an
applicant
with
substantially
the
same
ownership
could
come
back
and
obtain
re-licensure
of
that
building.
F
We
had
one
year
in
there
cabinet
one
and
seven,
thankfully,
that's
been
in
assisted
living
and
licensed
personal
care.
An
exceedingly
rare
situation
where
the
cabinet
has
success,
has
revoked
a
license,
and
we
looked
at
that
and
said
we're
not
all
about
protecting
someone
who
is
not
a
good
operator,
and
so
we,
we
said
fine,
seven
years
and
should
they
sell
the
building
or
should
they
substantially
change
ownership
within
their
group?
They
could
come
back
sooner.
F
And
then
another
change
in
the
committee
sub
is
requiring
that,
in
the
event
of
an
emergency,
a
provider
gives
priority
assistance
with
sufficient
staff
to
a
resident
who
needs
hands-on.
Help
to
ambulate
you'll
recall
that
in
the
pre-filed
bill
it
expands
from
no
staff
assistance
with
ambulation
to
one
person.
Staff
assistance
and
the
cabinet
was
fine
with
that,
but
they,
in
our
estimation,
correctly
raised
to
us,
wait
a
minute
we're
okay
with
this
expansion
in
order
to
help
people
age
in
place
etcetera.
F
However,
what's
in
the
bill
to
sufficiently
protect
those
people
because
they're
going
to
have
a
harder
time
exiting
a
building
in
the
event
of
an
emergency,
they
were
right.
We
built
that
in
additionally,
the
the
cabinet
had
also
raised
the
issue
about
a
licensure
survey
and
what
they
are,
the
the
not
licensure
survey.
I'm
sorry,
the
ability
of
the
cabinet
to
conduct
a
complete
initial
licensure
survey
before
licensing
a
new
applicant,
and
we
clarified
that
made
that
very
clear.
F
Last
thing
is
that
the
kentucky
justice
association
approached
us
a
few
days
ago
and
raised
a
had
a
couple
of
questions
raised
one
concern
and
sought
clarification
that
a
licensee
has
responsibility
for
operation
of
a
facility,
language
related
to
that
we
were
able
to
work
on
together
and
resolve
that
issue,
and
my
understanding
is.
The
association
was
fine
with
that
change,
though
those
are
the
significant
changes
in
the
committee
sub.
Vice
chair,
meredith.
A
Just-
and
I
said,
we've
heard
this
in
the
interim
in
detail
about
the
original
bill
and
again
I've
got
a
whole
summary,
but
I
think
mr
lee
kind
of
covered
a
lot
of
the
material
that's
in
there.
So
a
lot
of
input
has
been
brought
in
some
of
you
received
some
emails.
There
was
some
one
in
particular.
A
I
think
is
erroneous
that
we've
received
about
making
sure
that
you
know
that
there's
a
process
for
people
to
make
sure
that
they
have
training
requirements,
people
with
dementia,
we
passed
senate
bill
61
last
year
they
had
to
do
with
home
health.
I
think
that
was
your
bill
senator
meredith
and
bill
that
was
passed
that
required
the
cabinet
to
set
up
regulations.
On
monday
we
had
administrative
regulation
review
subcommittee
where
they
proposed
their
regulations,
and
I
think
all
of
you
should
have
a
copy
in
your
packet
of
910-4010.
A
It
applies
to
provider
agencies
and
in
the
list
of
that
provider
agency,
it
has
assisted
living
communities
that
employ
directly
or
by
contract,
aides
or
other
non-licensed
personnel
whose
work
involves
because
of
contracts.
So
you've
gotten
some
emails
saying
that
we
want
that
included
in
the
bill.
We
passed
a
bill
last
year
that
required
the
cabin
to
set
up
regulations
and
that
regulation's
been
established.
So
it
already
covers
that.
A
So
again,
I
think
a
lot
of
the
things
that
we've
heard
from
a
lot
of
the
different
agencies
has
been
put
into
the
sub
a
lot
of
work's
gone
into
this
looking
forward
to
this
and
kind
of
modernizing,
really
our
system
of
personal
care
and
assisted
living
facilities
in
kentucky
and
helping
people.
Really,
I
mean
you've
heard
lots
of
stories
of
people
who
might
be
in
one
of
these
who
perhaps
develop
a
terminal
condition
want
to
have
hospice
services.
A
G
Yes,
thank
you,
sir.
I
have
a
couple
questions
I
read
through
this
entire
bill
again
and
you
know
I'll
be
honest.
Is
somebody
who's
had
a
lot,
a
lot
of
personal,
familial
experience
with
the
long-term
care
process?
E
G
F
There's
not
a
nationalized
standard
in
terms
of
I
heard
two
questions.
One
is
a
nationalized
standard
and
second
is:
are
we
making
up
our
own
terms
right,
we're
not
making
up
our
own
terms?
What
we're
doing
in
kentucky
with
this
bill
is
aligning
with
virtually
every
other
state.
We
have
been
the
outlier
now
for
years
with
having
a
strictly
pure
social
model
of
assisted
living,
where
it
was
illegal.
F
A
podiatrist
has
to
do
that,
because
the
under
kentucky
law
is
interpreted
by
the
cabinet.
That's
an
example
of
a
basic
health
service.
F
F
All
we
can
do
currently
is
assistance
with
self-administration
and
now
under
licensed
personal
care.
We've
been
able
all
these
years
to
deliver
basic
health
services,
and
that's
all
this
bill.
Does
it
essentially
excuse
me?
It
essentially
merges
licensed
personal
care
apartment
style
for
the
kinds
of
residents
that
you
see
in
assisted
living
where
basic
health
services
can
be
delivered
already
with
assisted
living,
but
under
the
name
assisted
living
going
forward,
which
puts
us
with
virtually
every
other
state.
F
F
Then
they
then
they
had
to
have
been
and,
and
it
was
in
kentucky
in
louisville,
okay,
they
had
to
have
been
assuming
they
were,
and
I'm
sure
they
were.
Your
mother
wouldn't
have
been
there.
Senator.
F
F
It's
not
that
hospice
isn't
permitted
in
licensed
personal
care
currently,
but
it
there
is
no
provision.
If
someone
moves
beyond
mobility
criterion,
there's
no
provision
in
current
law
for
them
to
be
able
to
remain
in
their
home
in
that
licensed
personal
care
facility.
This
bill
changes
that
that
right
has
already
been
there,
the
last
11
years
in
assisted
living
communities,
thankfully-
and
it
keeps
that
all
I
can
all
I
can
respond-
is
to
say
if
they
were
delivering
health
services,
they
they
must
have
been
a
licensed
personal
care
facility,
not
assisted
living.
F
G
G
Oversight
oversight,
existing
facilities,
I
understand
new
facilities
coming
in,
they
have
to
meet
the
requirements
they
get
every
other
year.
Surveys
if
nobody's
going
to
die
and
once
a
year
survey,
if
somebody's
at
imminent
risk
of
death.
Don't
like
the
language.
I
would
like
to
make
sure
that
in
there
somewhere,
if
you
find
you
know,
if
you
have
a
survey,
you
find
somebody's
at
imminent
risk
of
death
that
that
gets
corrected,
and
then
they
get
on
six
months
and
then
a
year.
But
that's
okay,
but
I
don't
understand.
G
F
Because
it's
very
good,
the
the
under
this
committee
sub,
what
would
happen
is
an
existing
would
have
a
review
by
the
cabinet
before
being
re-licensed
as
a
an
assisted
living
community
with
dementia
care
and
that
review
in
the
case
of
an
existing
where
they've
been
operating
and
have
been
in
sufficient
compliance
that
they
hold
a
license
or
certification.
F
If
they're
assisted
living
that
would
take
a
strong
look
at
the
physical
plant
and
then
their
normal
review
process
would
certain
the
the
complete
survey
would
be
done
on
that
periodic
basis
and
again
I'll
remind
you.
The
average
duration
for
assisted
living
across
this
across
the
country
is
19
months.
F
We
went
with
12
as
frankly,
an
additional
reason
for
providers,
not
that.
I
think
we
need
it,
but
as
an
additional
reason
for
providers
to
strive
to
be
totally
compliant
and
the.
But
in
the
case
of
where
there
have
been
significant
concerns
in
the
preceding
cycle,
then
it
would
be
every
12
months
rather
than
every
24.
F
F
F
My
best
guess,
and
it's
more
than
a
guess,
I
think,
based
on
conversations
with
the
cabinet,
but
my
estimate
is
that
because
in
I
believe
every
case,
those
entities
that
do
not
deliver
that
are
not
permitted
to
deliver.
Health
services
are
regulated
by
the
department
for
aging
and
independent
living,
and
those
that
are
permitted
to
deliver
health
services
are
regulated
by
oig.
C
But
there
are
a
couple
things
that
I
want
to
get
clarification
on,
and
the
first
thing
is,
I
understand
that
there
will
no
longer
be
the
ability
for
an
assisted
living
facility
to
avoid
sanction
simply
by
extending
the
process.
Has
that
been
eliminated.
A
A
I've
heard
from
one
or
two
operators
that
are
upset
about
that
they
like
to
be
under
dale,
but
this
brings
everybody
under
the
office
of
the
inspector
general,
which
we
know
is
a
little
bit
of
a
different
tier
of
review
and
oversight.
So
I
think,
from
that
perspective
again,
people
are
gonna,
have
the
same
subject
to
review
right
now
all
nursing
homes,
as
we
know,
because
again
we
have
this
confusion
that
people
are
out
there.
They
don't
know
what
is
an
assisted
living
facility.
A
Personal
care,
home,
nursing,
home
nursing
homes
are
all
subject
to
oig
for
review.
This
brings
everybody
under
oig
for
review,
so
it's
going
to
have.
They
have
to
answer
that
same
regulatory
body.
If
there's
any
any
kind
of
an
investigation
that
takes
place,
oig
would
go
in.
Take
a
look
at
the
facility.
If
there's
a
complaint
right
now
from
someone
you
know
they
would
have
to
go
through
dale
for
those
facilities.
A
So
this
is
going
to
bring
them
underneath
that
regulatory
body
which,
if
there's
concern
about
hey,
do
people
have
a
chance
to
answer
that
we're
also
bringing
the
ombudsman
office,
which
is
a
group
of
advocates
who
are
looking
at
a
lot
of
these.
It
expands
their
purview
for
that
to
be
able
to
come
in.
This
is
an
agency.
That's
federally
funded.
We
don't
have
any
oversight
of
the
ombudsman
agency,
often
composed
of
volunteers,
but
folks
that
can
go
in
they're
supposed
to
be
problem
solvers
and
to
help
coordinate
some
of
the
care.
A
If
there's
concerns
or
issues
from
residents,
these
are
assisted
living
facilities,
personal
care
homes,
don't
get
any
federal
funding,
no
state
funding.
These
are
private
pay
individuals
who
are
basically
in
a
private
setting,
so
we've
got
that
organization's
involved.
We're
going
to
have
oig
involved
overseeing
a
lot
of
this,
so
I
think
from
that
angle,
there's
going
to
be
more
more
oversight.
C
Is
that
a
possibility
for
an
amendment?
Would
you
be
amenable
to
that
addition?.
A
C
The
senate
did
it
passed
out
a
committee
in
the
house
and
it
did
not
make
it
to
the
floor.
A
So
I
know
that
you
filed
that
bill
as
well.
I'm
not
sure
if
it's
something
we
can
discuss
for
sure
I
mean
as
far
as
a
possibility,
but
we'll
probably
take
it
up
with
the
group.
I
mean
a
lot
when
you
get
a
bill
like
this.
I
think
members
have
to
understand.
A
This
has
been
about
over
two
years
in
the
making,
and
so
you
have
a
lot
of
groups
that
have
come
together
to
agree
just
to
get
the
base
bill
was
kind
of
a
herculean
effort
and
then
from
there
to
get
other
groups
involved
to
ask
for
other
additions.
The
sub
is
a
product
of
that
that
not
only
do
the
other
groups
come
with
their
requests,
but
then
also
they
can
make
the
core
group
all
agreeing,
because
it's
not
just
one
agency,
there's
three
different
agencies
that
are
involved
in
this
that
are
discussing
it.
A
So
I
think
that's
something
we
can
discuss.
But
again
it's
going
to
probably
take
a
big
consensus
that
the
risk
being
that
the
whole
thing
falls
apart.
So
I'll
be
happy
to
discuss
that
with
you,
because
I'm
supportive
of
that
measure
senator
carroll,
I
know
you've
and
it's
something
I
think
we
probably
want
to
consider
passing
again
in
the
senate
and
hopefully
it'll
get
all
the
way
across
the
finish
line
but
can
definitely
discuss
it.
C
And
I
appreciate
all
your
work
on
this
and
all
the
efforts
to
make
these
facilities
better
and
to
offer
greater
services
for
our
people,
so
the
work
is
very
much
appreciated.
Thank
you,
mr
chairman.
D
Mr
chairman,
thank
you
and
in
the
presentation
you
mentioned
that
the
cabinet
had
some
suggestions
suggesting
changing
of
one
year
to
seven.
Yes,.
B
F
They
did
have
some
others
and
we
we
certainly
communicated
with
them
concerning
those
some
of
them.
We
didn't
necessarily
agree
with.
We
probably
the
biggest
example
I
can
think
of
senator
is
in
the
case
of
type
a
and
type
b
citations.
F
Those
are
essentially
a
an
element
that
comes
straight
out
of
federal
law,
related
to
medicare,
medicare,
isn't
applicable,
cms,
isn't
applicable
to
licensed
personal
care
or
assisted
living
in
kentucky,
because
there's
no
medicaid
waiver
there's,
as
senator
alvarado
said
it's
all
private
pay
and
while
type
a
and
type
b
distinction
on
violations
on
citations
with
fines
have
been
applicable
to
licensed
personal
care.
F
They've
been
used
very,
very
little
by
the
cabinet,
and
we
simply
looked
at
that
and
said,
even
with,
with
providing
being
a
for
a
provider
to
be
able
to
deliver
basic
health
services
at
the
level
that
is
being
done
in
licensed
personal
care.
Today,
it's
the
lowest
acuity
level
that
we
have
in
kentucky,
and
so
the
the
risks
of
real
problems.
F
Real
risk
for
residents
is
significantly
higher
in
a
skilled
environment,
where
much
broader
array
of
skilled
services
are
being
regularly
delivered
and
where
cms
rules
do
apply.
So
that
was
one
issue
where
we
just
thought
type.
A
and
type
b
with
civil
monetary
penalties
probably
didn't
need
to
apply
at
this
level
and
they
haven't
applied
for
22
years
in
assisted
living.
F
D
Good
thank
you
for
that
and,
mr
chairman,
if
I
could
briefly
follow
up
briefly,
thank
you.
The
violations
concerned
me
some.
As
I
read
the
language,
I
appreciate
the
change
from
the
way
the
bill
was
originally
filed
to
the
sub,
because
under
the
original
file
bill
there,
there
was
some
language
that
was
very
restrictive
as
it
related
to
the
ability
to
impose
civil
penalties,
very
restrictive
language,
still
somewhat
restrictive
in
in
the
sub.
But
I
don't.
I
don't
have
issues
with
that.
H
D
F
You
must
deliver
basic
health
services
to
the
residents
of
that
dementia
care
unit
and
what
forms
the
basis
for
that
removal
of
choice
from
the
provider
is
the
strong
belief
that
a
social
model,
dementia
care
unit
is
not
what
we
need
is
not
what
the
residents
on
that
unit
need,
because
they
are
the
most
frail
of
the
frail
that
we
care
for
sure,
and
they
are
the
ones
that
are
least
able
to
directly
communicate
their
problems,
their
needs
with
their
health
care.
Practitioners.
D
Excellent
explanation,
so,
in
my
in
my
lay
person's
mind,
we're
permitting
the
move
from
this
category
to
this
category,
not
not
exactly
but
to
a
layperson,
that's
what
we're
permitting
to
happen.
My
question
is
this:
as
as
these
entities
that
are
in
this
category
choose
to
move
over
into
the
personal
care
space
are
the
violations
the
same
as
they
are
currently
today,
stronger
or
lesser,
as
it
relates
to
the
cabinet's
ability
to
impose
penalties.
F
They
are
stronger
because
currently.
D
In
making
the
move,
I
simply
don't
want
to
hear
you
and,
and
you've
been
very
frank
with
me.
Thank
you
for
that.
If,
in
making
the
move,
you've
crafted
legislation,
that
also
lessens
the
burdens
of
oversight
and
penalties
than
I
have
concerns.
Thank
you
for
that.
That's
all
I
need,
mr
chairman,
thank
you.
E
Thank
you
and
we
do
need
to
move
on
senator
brooke.
I
know
you
have
additional
questions,
but
we
are
really
operating
a
terrible
kind
time
constraint.
We
have
two
more
bills
that
we
need
to
hear
and
I
want
to
make
sure
those
we
treat
those
people
fairly.
I'd
encourage
you
to
follow
up
the
central
alvarado.
You
understand
this
is
a
process,
but
we
do
have
one
other
person
wants
to
testify.
E
E
I
While
I
pull
this
up,
my
name
is
mackenzie
longoria,
director
of
public
policy
for
the
alzheimer's
association
here
in
kentucky,
I'm
chairman
alvarado
members
of
this
committee.
I
thank
you
for
allowing
me
to
speak
briefly
today
regarding
senate
bill
11.
I
am
here
as
a
representative
on
behalf
of
255
000
individuals
living
with
dementia
and
their
caregivers
throughout
the
commonwealth.
I
Since
this
major
restructuring
to
the
assisted
living
system
in
kentucky
was
first
discussed
and
proposed,
the
alzheimer's
association
has
worked
in
good
faith
to
seek
reasonable
changes
to
this
bill
that
would
protect
people
living
with
alzheimer's
and
dementia.
I
must
note
that
we
are
very
appreciative
of
some
changes
that
have
been
made
in
a
prior
draft
of
the
build
that
we
have
seen
specifically.
However,
the
association
has
sought
to
include
dementia
training
in
all
assisted
living
settings
and
to
ensure
uniform
standards
across
the
industry
in
the
provision
of
dementia
care.
I
Unfortunately,
we
have
not
been
met
with
the
same
good
faith
that
same
good
faith
from
the
industry
representatives
in
an
effort
to
find
a
reasonable
compromise.
The
association
approached
the
industry
with
an
offer
to
drop
our
demand
for
dementia
specific
training
in
the
regular
assisted
living
setting.
If
the
uniform
standards
were
applied
to
all
assisted
living
communities
applying
for
dementia
care
licensure,
we
offered
to
make
this
major
concession
to
meet
the
industry
in
the
middle
and
to
get
to
a
place
with
agreed
language.
I
I
Importantly,
the
creation
of
a
new
insisted
living
community
with
dementia
care
license
is
incredibly
flawed.
In
this
bill,
the
late
bill
lays
out
several
requirements
that
a
facility
must
meet
before
being
issued
a
license,
as
we
heard,
including
addressing
education
and
experience
in
managing
residents
living
with
dementia.
I
This
section
represents
some
of
the
absolute
best
practices
of
the
association,
but
these
critical
sections
apply
only
to
new
facilities.
Existing
dementia
units
in
operation
of
the
effective
date
of
this
act
are
grandfathered
into
this
newly
created
licensure
system
without
having
to
meet
these
important
education
and
experience
requirements.
This
is
unacceptable.
I
Why
should
some
assisted
living
facilities
and
personal
care
homes
that
will
be
absorbed
not
be
held
to
the
same
high
standards
just
because
they're
already
in
existence?
The
answer
to
that
question,
unfortunately,
at
this
point
in
time,
is
because
the
industry
is
pushing
this
bill
and
it
is
not
ethical
and,
frankly,
it
prioritizes
profits
over
resident
needs.
I
Our
current
assisted
living
system
is
not
perfect,
and
the
association
recommend
recognizes
that
it
is
past
time
to
move
away
from
a
certified
social
model
only
system.
We
support
the
creation
of
this
two-tiered
licensure
system,
but
replacing
our
out-of-date
system
with
a
new
licensure
that
appears
appears
to
protect
residents,
while
really
shielding
existing
facilities
from
equal
standards
is
wrong.
We
have
a
chance
to
create
a
new
and
better
model,
but
it
must
protect
residents
and
staff
in
all
settings,
and
the
current
draft
unfortunately
does
not
achieve
these
important
priorities.
I
As
we
have
stated
over
and
over
again,
the
association
wants
to
be
in
a
position
to
support
this
bill
and
work
together
to
improve
the
assisted
living
landscape
in
kentucky.
However,
the
current
iteration
is
not
one
that
we
can
support
as
representatives
of
hundreds
of
thousands
of
kentuckians
impacted
by
alzheimer's
and
dementia.
I
We
are
asking
the
members
of
this
committee
to
oppose
this
current
iteration
of
the
bill
so
that
we
can
work
together
to
create
parameters
for
assisted
living
licensure
that
enables
the
industry
to
supply
critical
living
services
that
they
are
excel
at,
while
also
protecting
the
needs
and
safety
of
all
residents.
I
will
close
with
one
final
thought:
I
was
in
the
cafeteria
yesterday
getting
some
lunch
and
I
handed
my
card
over
to
the
cashier
and
on
my
card
it
says
alzheimer's
association.
I
E
Thank
you.
Any
questions
comments
senator
nemas.
Yes,
I
might
be
a
little
bit
confused
if
you
clear
this
up.
Are
you
against
what
is
in
the
bill?
Are
you
against
the
bill?
Because
it
doesn't
have
something
additional
that
you
want
in
it.
I
A
Thank
you,
ms
longoria.
Listen!
I
like
you
personally.
Those
comments
are
insulting
to
me.
I'm
a
provider,
I'm
a
doctor.
I've
devoted
my
devote
my
life
currently
to
taking
care
of
people
in
nursing
homes.
They
have
dementia
to
imply
that
this
bill
that
has
my
name
on
it,
is
for
the
sake
of
profits
and
after
making.
The
betterment
of
people
is
an
insult
to
me
and
to
the
people
that
take
care
of
a
lot
of
these
folks.
A
The
alzheimer's
association
was
involved
in
this
process.
Early
on,
you
had
20
requests,
20
plus
requests.
All
of
those
have
been
incorporated
for
one,
and
if
you're
saying
I
don't
have
my
full
20,
I've
only
got
19.
I'd
rather
have
the
whole
bill
die
is
insulting.
It's
not
how
frankfurt
works.
I
hate
to
tell
you
I
mean
20.
Things
have
been
requested
to
say
that
you
were
not
included
in
this
process
is
not
true.
Factually
incorrect.
You
were
involved
in
this
process
early.
A
We
sought
requests
19
of
the
20
things
that
you've
requested
have
been
incorporated
into
this
bill
and
they
said
well,
I
didn't
get
my
20th,
so
I'm
an
opposer,
your
organization
is
an
insult
frankly
to
me
and
imply
this
is
being
done,
for
profits
is
an
insult.
I
don't
do
things
for
profit
here.
People
know
me,
I'm
pretty
passionate
about
health
care
and
I'm
pretty
passionate
about
being
a
doctor.
I
take
a
lot
of
pride
and
when
someone
says
you're
putting
money
before
patients
is
an
insult
to
me,
you
can
ask
all
of
my
colleagues.
A
I've
had
those
discussions
behind
closed
doors.
I
don't
do
things
that
way.
This
is
to
improve
the
care
to
modernize,
kentucky's
health
care
system
and
to
say,
hey.
I'd
rather
have
zero
percent
than
95
percent.
I
think
is
a
bad
approach
to
health
care.
Mr
chairman,
I
would
ask
for
a
vote
on
this
measure.
Thank
you.
E
G
I'm
going
to
vote
I
and
would
like
the
chance
to
explain
my
vote.
Please.
G
Thank
you,
sir.
I
will
try,
I
think,
there's
some
really
good
things
in
this
bill.
I
think
this
is
a
system
that
desperately
needs
to
be
updated.
I
think
this
bill
personally
is
extremely
confusing.
I
can't
even
figure
out
where
my
own
family
members
would
fit
in
these
facilities
and
that
bothers
me
a
little
bit.
G
A
Aye
the
matter
was
reported
favorably.
The
final
vote
is
nine
yeses,
no
zeros
and
no
pass
votes.
Thank
you
very
much.
It'll
be
reported
fairly
to
the
senate
floor.
The
next
item
on
the
agenda
is
senate
bill
55.
It's
an
act
relating
to
certified
stroke,
centers
the
sponsor
senator
don
douglas
dr
douglas.
If
you'd
like
to
approach
the
table,
I
think
we
have
also
a
guest
if
you'd
like
to
both
introduce
yourselves
to
the
record
and
begin
your
testimony
whenever
you're
ready.
H
B
Thank
you,
chairman
alvarado,
vice
chair
meredith,
members
of
the
committee.
I
am
shannon
smith
with
the
american
heart
association,
and
this
bill
adds
a
level
of
care
to
our
current
stroke
systems
of
care,
including
thrombectomy
capable
centers.
Currently
we
have
three
levels
of
care
in
kentucky
we
have
acute
primary
and
comprehensive.
B
This
includes
thrombectomy
capable
this
is
a
procedure,
a
surgical
procedure
that
removes
blood
clots
from
large
vessels
or
organs.
Most
of
the
time
it's
arms
or
limbs
it
can
be
organs,
so
this
includes
thrombectomy
capable
centers,
and
then
it
just
clarifies
within
the
language
that
it
says
primary
and
it
changes
it
to
certified
because
primary
is
a
level
of
care.
So
those
are
the
only
changes
and
updates,
and
if
there
are
any
questions.
A
G
A
Aye
very
good.
The
matter
passes
favorably
with
eight,
yes,
votes,
one
pass
and
no
no
votes.
So
congratulations,
dr
douglas,
and
you
will
be
seeing
a
lot
and
you're
gonna
be
seeing
more
of
you
because
you
have
a
next
bill
as
well,
but
congratulations
on
this
is
your
kind
of
first
bill
being
presented.
Thank
you
very
much
for
your
testimony.
Thank.
A
Next
week
we
also
got
senate
bill
56,
which
is
an
act
relating
to
opioid
antagonists,
designed
to
reverse
the
effects
of
an
opioid
overdose.
The
sponsor
is
also
senator
don
douglas
and
if
you
have
any
other
guests
which
are
joining
you,
I
think
there's
some
might
be
joining
here
in
person
or
by
zuma.
I
think
they're
online.
I
think
we
have
dr
phil
skolnick
who's,
the
chief
scientific
officer
for
opiate
pharmaceuticals,
dr
skolnik,
are
you
online?
A
A
H
I
would
like
to
start
first,
mr
chair,
I'm
here
to
introduce
this
bill.
This
is
senate
bill
56.
I
call
it
the
opiate
antagonist
bill.
The
opiate
antagonist
is
designed
to
reverse
the
deadly
effects
of
opiate
overdose,
whether
these
overdoses
occur
in
the
hospital
setting
or
in
the
community.
Setting
now
naloxone
has
been
the
standard,
and
this
is
what
our
first
responders
have
used
for
many
many
many
years
and
has
played
a
critical
role
in
saving
many
lives.
H
J
By
way
of
background,
I
led
the
nih
team
that
developed
the
concentrated
naloxone
nasal
spray.
This
resulted
in
the
fda
approval
of
what
is
now
known
as
narcan
nasal
spray.
I've
spent
more
than
32
years
at
the
national
institutes
of
health,
most
recently
as
a
director
of
the
national
institute
on
drug
abuse,
division
of
therapeutics
and
medical
consequences
where
we
focused
on
the
development
of
pharmacotherapies
for
addiction.
J
Public
policy
must
continually
be
updated
to
ensure
that
innovative
rescue
medications
such
as
rapidly
absorbed
high
potency,
long-acting
opiate
antagonists,
can
enter
the
marketplace
and
be
made
available
to
the
medical
community
first
responders
and
ems,
as
well
as
kentucky
citizens
as
written
senate
bill
66
will
not
allow
people
in
kentucky
access
to
all
reversal
agents.
The
downstream
consequence
could
include,
but
not
limited
to
confusion
regarding
which
reversal
agent
can
be
utilized
simply
stating
simply
stated
in
light
of
the
rising
number
of
opiate
overdose
deaths
in
kentucky.
J
J
These
updates
are
essential
to
allow
anyone
to
use
next
generation
fda,
approved,
reversal
agents
regarding,
regardless
of
their
molecular
nature,
the
current
language
in
the
kentucky
statue
restricts
good
samaritan
and
standing
order.
Access
to
next
generation,
opiate
antagonists
standing
order.
Legislation
has
been
put
in
place
to
provide
increased
access
for
anyone
who
wants
a
reversal
agent
on
hand
simply
by
walking
into
a
pharmacy
good
samaritan.
Legislation
was
intended
to
limit
concerns
of
risk
and
liability
when
assisting
those
in
dire
need
of
help.
J
If
these
two
essential
components
of
the
kentucky
statute
are
not
updated
with
molecule
agnostic
languages
that
applies
to
all
fda,
approved
reversal
agents.
This
will
limit
access
to
highly
effective,
potentially
life-saving
medications,
an
area
that
desperately
needs
to
be
expanded
when
the
statute
was
initially
written,
naloxone
was
the
only
fda
approved
molecule
to
reverse
overdoses.
J
J
According
to
cdc
overdose
data,
in
the
12
months,
ending
may
2021
kentucky
had
an
estimated
2267
deaths
due
to
an
opiate
overdose.
This
is
a
significant
increase
from
the
previous
year's
number
of
1647,
which
represents
almost
a
38
year-over-year
increase.
These
numbers
are
staggering
and
likely
reflect
the
increased
misuse
of
high
potency
synthetic
opioids
like
fentanyl.
J
According
to
a
report
by
dr
slavova
and
quistenberry
at
the
university
of
kentucky
death
rates
from
opiate
overdoses
among
african
americans
rose
57
in
kentucky
from
2019
to
2020..
We
must
make
certain
that
underserved
communities
have
access
to
all
available
reversal
agents
with
adequate
good
samaritan
protections
to
reduce
these
statistics.
J
Recently,
nida
reported
one
in
20.
People
who
presented
an
emergency
room
with
an
overdose
die
within
the
next
12
months
of
an
overdose
and
that
two-thirds
of
these
individuals
die
from
subsequent
opioid-related
overdose.
This
is
a
really
startling
statistic
based
on
evidence
from
states
such
as
new
mexico
and
new
jersey.
J
A
Dr
dr
skolnick,
I'm
going
to
interrupt
you
just
for
a
moment.
We
have
a
motion
on
the
bill.
Is
there
a
second?
You
have
a
second.
I
think
the
basics
of
the
bill
is
effectively
that
we're
getting
rid
of
a
specific
name
of
a
drug
in
the
bill
and
replacing
it
with
a
generic
class
of
that
that
drug
is
within
to
expand
the
ability
to
be
able
to
treat
this.
We
appreciate
that
you've
got
a
lot
of
material.
We
do
have
a
tight
schedule,
however,
and
we
do
a
motion
in
a
second.